Juicebox Podcast: Type 1 Diabetes

Episode #1791 - "Control Without Obsession"

Host: Scott Benner
Guest: Jenny Smith (Certified Diabetes Educator, T1D for 37+ yrs)
Date: March 6, 2026

Episode Overview

This episode centers on strategies for living well with Type 1 diabetes without falling into unhealthy obsessions—a conversation about progress, frustrations, and hope in the diabetes tech and care landscape. Host Scott Benner and CDE Jenny Smith candidly discuss new tech, ongoing pain points, and the importance of community and feedback. Listeners get a detailed, honest, and often humorous look at what’s working, what’s not, and what patients and caregivers truly want from diabetes management today.

Key Discussion Points & Insights

1. Excitement About New Technology: The Twist Pump

• Jenny shares her enthusiasm for the new Twist hybrid closed-loop insulin pump ([03:23]).
  • Offers features many in the community have wanted: lower targets, more control, compatibility with multiple CGMs (currently Libre 3 Plus and Eversense 365; Dexcom possibly coming).
  • Built with input from the DIY “Loop” algorithm community.

  "I really am... It's a step in the right direction... targets that are lower... the way the algorithm works... with control knobs you can turn." — Jenny [03:30]

• Algorithm currently temp basal–only (does not yet incorporate auto-bolus), but targets can go as low as 87 mg/dL ([05:27]).
• Apple Watch compatibility: major benefit for discretion, particularly for children in school ([06:57]).

2. Interoperability and Frustrations with Slow Progress

• Discussion about barriers to integrating new features and expanding device compatibility ([04:28], [11:09]).

  "If there weren't halting factors in getting adjustments to our technology... it's slow. That is a common thread." — Jenny [11:20]

• DIY community and patient-driven innovation outpaces commercial product updates.
• Desire for end-user (patient) input in development and regulatory panels ([13:03]).

3. The Value and Limits of Provider Lists

• Scott introduces the redesigned “Juicebox Docs” repository, now searchable for patient-friendly and DIY-friendly endocrinologists ([07:39]).
  • Reflects the need to find providers supportive of individualized and loop-based management.
• Jenny: Those willing to work with DIYers tend to think outside the box and individualize care ([09:43]).

4. Pain Points in Diabetes Tech

a. Settings/Algorithm Backups ([23:05])

• Major frustration: adaptive algorithms (e.g., Omnipod 5, Medtronic) do not back up customization/settings to the cloud.

  "If I drop my phone in the toilet, they're all gone... Have you heard of the Internet? Do you know what the cloud is?" — Scott [24:26]

• HIPAA and technical excuses flagged, but both hosts insist on the necessity and feasibility, even with anonymization.

b. Lack of Simple, User-Requested Features

• Example: Delta (glucose change) display on CGMs, a longstanding user request ignored by companies ([18:00]).

  "The whole community wants that thing—to show delta 100%... It's the reason that it's in the DIY stuff." — Jenny [18:58]

c. Device Discontinuation Dilemmas

• Frustration over ending support for devices that work reliably for some (e.g., Dexcom G6), forcing users to switch ([31:28],[32:35]).
  • Companies face resource limitations and have to shift focus for progress, likened to discontinuing older car models ([33:08]).

5. Balancing Critique with Gratitude

• Both hosts repeatedly emphasize how far technology has come, even as they critique shortcomings.

  "Thank God... they’re doing this stuff... if they weren't, you'd get what you get and that would be it." — Scott [35:45]

• Acknowledge device shortfalls but remain positive about advances’ impact on health, quality of life ([28:03], [31:00]).

6. Hope for the Future: Stem Cell Therapy and AI

• Jenny expresses hope for emerging implantable cell therapies (beta-cell encapsulation, immune system breakthroughs) to reduce burdensome daily management ([38:20]).
  • Recognizes therapy advances over the elusive "cure," as well as the power of AI to accelerate research ([41:49]).

7. The Cost of Wasted Time: Importance of Practical Knowledge

• Addressing the emotional cost of wasted years due to poor diabetes education ([42:54]).

  "The greatest sin is to waste time. Life is just too short... I've had diabetes for 10 years, no one told me to prebolus..." — Scott [43:15]

• Urges companies and HCPs to “feed the soul” with incremental progress, not vague promises.

8. Provider Knowledge Gaps: The Need for Better Clinical Education

• Discussion of how some endocrinologists lack practical, lived understanding of T1D ([55:24]).

  "I just spoke to an endo, and I feel like I know way more about managing type 1 diabetes than this doctor does. Is that really possible, or am I a narcissist?" — Scott [55:24]

• Jenny retells alarming stories of poor guidance (e.g., family denied a glucagon prescription) ([56:07-58:19]).
• Sincere call for humility and knowledge sharing among clinicians:

  "Educators and endos should be doing the same as car companies—looking at what makes patients successful." — Jenny [50:45]

9. Community, Shared Learning & the Power of Conversation

• Both reflect on the power of their ongoing partnership and the Juicebox Podcast’s impact. Sharing successes helps others aim higher, even if not everyone achieves the same outcomes ([53:23]).

  "If this idiot’s doing it, maybe I could figure it out." — Scott [53:57]

• Podcast and community provide a scalable way for knowledge and hope to reach far beyond what any single provider can handle ([50:34]).

Notable Quotes & Moments

• Jenny on user-driven tech and lower targets ([05:27]):

  "The targets go as low as 87... for people pregnant or planning pregnancy, now the target is already there."

• Scott on device interoperability ([09:25]):

  "We started this list as doctors who wouldn't laugh at you if you said, ‘I listened to a podcast...’"

• On lack of true end-user input in product design ([13:02]):

  "Was anybody with diabetes on this board of configuration—who thought this was a good idea?" — Jenny

• On companies’ resistance or sluggishness ([20:30]):

  "Please, can you add delta? People are asking for delta... it's on the list...'What list?'" — Scott & Jenny

• On setting expectations for progress ([34:34]):

  "Arden's had diabetes... it has always gotten better. Two steps forward, one step back... farther ahead than we were." — Scott

• On emotional impact of poor clinical advice ([57:19]):

  "Told them this... a pediatric endo told this family, 'you don't need glucagon.'" — Jenny

• On hope vs. false promises ([41:10]):

  "I'm more hopeful for therapies that actually navigate an issue, not technically be solved, but there's an outside way..." — Jenny

• On sharing therapy and management insights ([48:59]):

  "The descriptive way you explain something, it helps me talk through things in a different manner with people..." — Jenny

Timestamps – Segment Guide

• 03:23 | Jenny’s excitement about the Twist pump
• 07:39 | Juicebox Docs directory & finding out-of-the-box clinicians
• 11:09 | Frustrations with slow tech progress and regulatory drag
• 18:00 | The ignored delta request & user-driven CGM features
• 23:05 | Algorithm backups missing—device pain points
• 31:28–34:34 | G6 discontinuation, progress vs. user needs
• 38:20 | Hope in cell therapy and AI-fueled research
• 42:54 | Wasted time, pre-bolusing, and the importance of knowledge transfer
• 50:30 | Community scaling, educator/endo learning from patient experiences
• 55:24 | Do patients sometimes know more practical management than doctors?
• 56:07-58:19 | Alarming provider stories (e.g., no glucagon prescribed)
• 64:56 | Directory flag for “provider with type 1” badge

Overall Tone & Takeaways

• Candid, honest, and humorous, punctuated by both optimism and frustration.
• The hosts celebrate clear wins and progress but refuse to paper over real shortcomings in tech, education, and clinical care.
• There is a strong call for industry and clinicians to prioritize actionable community feedback and patient experience.
• The conversation models the kind of two-way learning that is often missing in clinical environments.
• Resonant themes: community wisdom, empowering patients, patient-driven progress, hope for the future without naivete about challenges.

For Listeners: Actionable Summary

• If you want clinicians who “get it,” use resource lists like Juicebox Docs and seek those open to DIY/loop approaches.
• Advocate for feature requests, both to tech companies and in your clinical care. Your voice matters.
• Keep perspective: Progress is uneven; not every product or provider will be a perfect fit—stay flexible and engaged.
• Share your struggles & wins: Community learning can shorten the path for someone else.
• Don’t accept poor care: Seek out those with humility, curiosity, and willingness to listen and learn.

(End of summary)